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BFAR advice needed

I am new to posting on the forum, but I have loved reading the threads and all of the great advice on here since before my son was born. Now it’s my turn – I could use some advice.

My son was born on June 26th, so he is about three-and-a-half weeks old. He was born via c-section, after 26 hours of labor during which I only dilated 5 cm, and during which I developed an infection (Chorioamnionitis) and a fever. My son was taken to the NICU right after birth, because they were worried that he had gotten the infection, and he stayed there under observation for 12 hours. I was taken to recovery for an hour before being transferred to a post-partum room, and the soonest I was able to see my son was three hours after his birth. I did attempt to breastfeed him at this point, and we had about 15 minutes of time at the breast, but he then had to return to the NICU and stay for the remainder of the 12 hours before being allowed to room-in with me.

Also, another vital piece of my history is that three years ago, I had a breast reduction. My nipples were not removed, but I developed an infection on the left side, and the nipple was damaged a bit from the infection. The right side healed normally, with no infection.

While he was in the NICU, my son received supplementation via bottles, and he has been supplemented with formula from then on. I sincerely regret this, but I recognize that with my surgery the likelihood was high that he would need supplementation of some sort. What I need help with is figuring out how to supplement while still maintaining the milk supply that I do have.

When my son was born, he weighed 7 pounds, 6 ounces. When we left the hospital, he was 6 lbs 13 oz. At his first check-up after leaving the hospital, when he was five days old, he was back up to 7 lbs 3 oz, and then at his two-week checkup (he was actually 16 days at that point) he was back up to his birth weight, 7 lbs 6 oz. Today (he is 3 weeks, 2 days old) we were back at the doctor and had his weight re-checked, and he was 7 lbs 9.5 oz. I think his weight gain is okay so far, but this is with daily supplementation, not EBF’ing (I’d like to EBF but don’t know if it’ll be possible with my history).

As far as diapers, he normally has between 7 and 9 wet diapers a day. As far as dirty diapers, he normally has 2 VERY poopy diapers, and 3 or 4 more diapers with a very small amount of poop.

Another issue is that he falls asleep at the breast very easily – within ten minutes EVERY SINGLE TIME, and he is very hard to rouse. If I then put him in his bassinet, or if my husband takes him, he typically (though not always) wakes up and exhibits hunger cues again. I know this can be normal, but it just makes me stress about my supply even more.

Pumping is also an issue for me. The most I have ever pumped is 2 oz between both breasts, and normally it’s between 1 and 1.5 oz. I also can’t figure out how to pump after feeding him – since he wakes if I move him to anywhere but on me, I typically just allow him to sleep on me until he wakes naturally, leaving no time for pumping. I know pumping can be very helpful to increasing my supply, but I just don’t know how to make it work.

As far as his current supplementation, he has been getting formula from a bottle an average of 2 or 3 times a day, and I normally give him 2 oz when he gets a bottle. He has taken 3 oz two different times, but normally its just 2 oz.

SO, after all that, here are my questions: what should my action plan be? Should I allow him to nurse until he falls asleep, and then put him in his bassinet, and if he awakens and is hungry, then give him a bottle? Should I allow him to nurse for a set amount of time before supplementing? Should I pump exclusively? How do I work in pumping? What do I do?

I have been so stressed and discouraged about this whole situation, because I want him to thrive and gain weight appropriately and be healthy, but I also wish that I could provide all of his nutrition myself, without any supplementation. I don’t want my selfish desire to EBF to get in the way of his health and ability to thrive, however. I’m just so lost.

Re: BFAR advice needed

SO, after all that, here are my questions: what should my action plan be? Should I allow him to nurse until he falls asleep, and then put him in his bassinet, and if he awakens and is hungry, then give him a bottle? Should I allow him to nurse for a set amount of time before supplementing? Should I pump exclusively? How do I work in pumping? What do I do?

Here is what i suggest. Nurse baby until he falls asleep, then keep holding him. As soon as baby stirs, nurse again. If baby is excessively sleepy at the breast, try ideas for keeping baby actively nursing such as breast compressions and switching sides. If baby is fussy and won’t nurse, try a small amount of milk in a bottle then switch back to the breast.It is NORMAL for a baby to want to nurse again a very short time after "finishing." That is normal no matter how much milk mom makes. So, I would suggest, always offer to nurse first.

Use the basinet for baby for when YOU need it -to use the bathroom, take a shower, to pump, or eat. Have someone else prepare your food and do all other chores as much as possible. YOU keep holding baby. You may discover that baby will cue and nurse right in his sleep, may nurse and latch better when calm, and may even gain better due to being held and close (skin to skin if you like) to you for most of the time. A baby’s natural habitat is ON MOM, not IN a bassinet.

Learn the signs for baby getting "enough"-poops, pees, and content baby right after nursing. Consider weekly or every other week weight checks to keep on top of gain. If all these are looking good, you can start weaning slowly off the supplements, by making them smaller and less frequent, gradually. ONLY BY (slowly) WEANING OFF SUPPLEMENTS will you know if you can make enough. You can ALWAYS add back in supplements IF NEEDED.

Pump with a good, double sided electric pump or a hospital grade rented pump. As long as baby is getting supplements, Pump as much as you can, but it need not be at any particular time. Pump when supplements are given by someone else, and/or after nursing sessions, or when ever works for you. At this age, milk needs to be removed from the breasts AT LEAST 10-12 times a day. The Pump OR baby can do this. The more baby nurses well, the less you have to pump. Pump sessions should be short, 15 minutes per side to start, adjust as necessary. NURSING sessions may be much longer. That is normal.

You had a rough start, plus with your surgery think you cannot make enough. But many mothers who had issues ion the early days and have had breast surgery-even breast reduction surgery, DO make enough. We have no idea at this point if you can or not.

Even if you cannot make "quite" enough, it is important to maximize what you can provide baby. Needed supplements are fine, but don’t let supplementing/pumping/bottles overtake the breastfeeding. YOU DO make milk, and your baby DOES nurse at the breast, I strongly suggest that you build on those two very positive aspects of your situation, not toss them away by going to all pumping....

You can also consider galactagogues- There is LOTS more you could be doing to increase your production.

The most I have ever pumped is 2 oz between both breasts, and normally it’s between 1 and 1.5 oz

This is NORMAL pump output. Many mothers have to pump more than once to get enough for a feeding. And a 3 weeks old baby typically takes in 1-3 ounces per session. (And should never get any more than that by bottle-keep bottle feedings small and slow) And babies are better than pumps (usually) at extracting milk.

I strongly suggest the book Making More Milk. One of the Authors, Diane West, IBCLC, also breastfed after breast reduction surgery.

If you can, you also may want to hire a board certified lactation consultant to help you with the weaning from supplements process

Re: BFAR advice needed

PS The idea that a mother is being "selfish" in trying to breastfeed depite difficulties is total nonsense. If anyone is laying that kind of nonsense on you, ignore them. Breastfeeding is normal, all alternatives are subnormal. Of course, you want to maximise your ability to breastfeed your child. It just makes good sense!

Re: BFAR advice needed

Meg, thank you so much for taking the time to respond. I think your suggestion of just nursing anytime he stirs is what I needed to hear. My only issue is keeping him from being excessively sleepy. I have tried breast compression, and it only seems to help for about two minutes before he stops responding even to the compressions. Also, switching sides is difficult because of the damage to my left side. My nipple on that side is not normally shaped anymore, and he has trouble latching on to that side. I have met with an IBCLC, when he was eight days old, and she helped me with the latch, but he still struggles on the left side. Should I try a nipple shield, maybe?

I do typically just allow him to sleep on me, except for when I need to shower, use the bathroom, or eat. He also sleeps in his bassinet at night, right next to our bed. I just hate that he always starts I cry when I go shower, eat, or use the bathroom, and I always come get him right away. When he is awake and alert and content his dad will hold him to get some bonding time, but the majority of the time he is with me, skin-to-skin, with the help of a My Breast Friend.

I was thinking about renting a scale to do daily weight checks - think that's a good idea, or will it just stress me out and I should stick to weekly checks?

I have a Medela Symphony rented, and that's what I've been using since his birth. I'm not sure I have exactly the right size flanges, though, especially for my damaged left side. I think I've been pumping for too long when I do pump, typically about 20 minutes. I would like to pump after nursing sessions, but I can't figure out how to pump while he is laying with me. Suggestions there? I'm glad that my pumping output is normal, at least - that's reassuring to me.

I also forgot to mention the galactagogues. I've been taking fenugreek and blessed thistle since he was six days old. I started mothers milk tea this past week, along with Reglan, and I just started taking More Milk Plus on Thursday. Any other galactagogues I should try?

I read Diane West's other book, Defining Your Own Success, but I will definitely get Making More Milk as well.

And finally, I have an appointment with a different IBCLC on Monday, so I am hoping that goes well!

Re: BFAR advice needed

Oh, and I had considered an at-breast supplementer, but the first IBCLC I saw suggested against it, because she thought that once his latch was better, which she helped me with, I wouldn't need it and it would just add to my stress level. Should I reconsider?

Re: BFAR advice needed

Re: Nipple shields and lactation aid: Both of these CAN be very helpful tools. But they are not helpful in every case! So yes, this will be an individual decision.

Generally, if you are close to not needing to supplement baby at all, I would agree, hold off on an aid. If it looks more and more like supplementation will be an ongoing part of your breastfeeding experience, then it may become a very helpful, timesaving tool. I suggest, read the info about lactation aids I linked-in particular the CW Genna article, and watch the video, and see what you think. YES there is a learning curve and no, not all moms like using these devices. But they can help. It's just so individual.

A nipple shield is cheap (less than $10) so there is not much invested monetarily, so that is certainly worth a try if to see if will help your baby be able to latch on the one side. A baby nursing with the help of a sheild IS nursing at the breast, so when they work, they are a good thing. More on shields: http://kellymom.com/bf/concerns/child/wean-shield/

You CAN try to "make at home" your own lactation aid as well, to see if it would be something that you would even consider before making a larger investment.

In case you were wondering shields and lactation aids can be used together, quite successfully.

I have a Medela Symphony rented, and that's what I've been using since his birth. I'm not sure I have exactly the right size flanges, though, especially for my damaged left side. I think I've been pumping for too long when I do pump, typically about 20 minutes. I would like to pump after nursing sessions, but I can't figure out how to pump while he is laying with me. Suggestions there? I'm glad that my pumping output is normal, at least - that's reassuring to me.

Gotta have the right size flanges. VITAL. Bring your pump to your appt so she can watch you pump. If you cannot find what you need from Medela, you can look at flanges made by Pumpin Pals.

have you tried hand expression or breast compressions (or both) before/during/after pumping (as works for you?) that can increase pump output.

but I can't figure out how to pump while he is laying with me. Suggestions there?

Hmmm-is baby lying next to you, and you lying on your side, or is baby more on top of you and you are reclined? Baby is asleep? where are you guys?

Re: BFAR advice needed

I was thinking about renting a scale to do daily weight checks - think that's a good idea, or will it just stress me out and I should stick to weekly checks?

Personally I am not a big fan of such frequent weight checks. Gain naturally fluctuates day to day anyway, so that can throw a mom off. I dont think there is any NEED for that much measuring. There are so many other reliable signs of how things are going.

HOWEVER, I have known more than one mom who felt empowered by being able to do frequent checks, one who is even doing several before and after nursing weight checks a day. In her case, that helped her cut back on the supplements, because she so needed teh "confirmation" baby was getting enough. She admits it IS stressful to do all those checks but in her case the alternative is more stressful.

Re: BFAR advice needed

Okay, I think for right now I will do more research about the lactation aid, especially the resources you provided, and will see how things play out with the supplementation. I also think I'll get a nipple shield tomorrow to see if that helps on the left side. If it does help him latch on to the left side, will I need to use it on the right side as well, or will it not effect his ability to latch on to he right side?

I will definitely bring my pump to the appointment to get her input. I've tried looking at pictures to figure out the right size, but it's hard to interpret.

I haven't done breast compression while pumping, only while nursing. I'll try that next time. I have done some hand expression, but I find it hard with my breasts being so large to get a good hold on them. Does KellyMom have a page about hand expression?

When I say he's laying on me - I'm on the couch, reclined only slightly. I have the My Brest Friend around my waist, and he is laying on it, but pressed right up against me, either chest to chest or his side to my chest, and he is sleeping/dozing. With my breast size, my flat nipples, and the falling asleep issues, I find it very hard to nurse without the pillow.

Re: BFAR advice needed

If it does help him latch on to the left side, will I need to use it on the right side as well,

no. use it only where needed

When I say he's laying on me - I'm on the couch, reclined only slightly. I have the My Brest Friend around my waist, and he is laying on it, but pressed right up against me, either chest to chest or his side to my chest, and he is sleeping/dozing. With my breast size, my flat nipples, and the falling asleep issues, I find it very hard to nurse without the pillow.

can you put the pump on a low table right next to or in front of you, sit up as much as you need (leaving baby lying on breast friend) and sort of scooch baby over to one side and pump on the other?